Date Published

September 13, 2023

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: Can a paramedic in the field rule out ischemic chest pain and not treat with ASA/Nitro due to the chest pain being reproducible? (eg. worse on deep inspiration but radiating down the left arm/shoulder, and sharp pain in left upper chest and pressure across the lower chest). I recently had this call, and was told that you can rule it out based on it being reproducible, but the history and rhythm strip, clinical presentation was leaning more towards cardiac.


A paramedic in the field cannot rule out ischemic chest pain due to it being reproducible. The only way to ensure that chest pain is not ischemic in nature is to complete comprehensive testing including bloodwork and other diagnostic tests not available in the prehospital environment. Chest wall tenderness or reproducible pain has been reported in up to 15% of patients ultimately diagnosed with acute MI.

Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes.

JAMA. 2005 Nov 23;294(20):2623-9. doi: 10.1001/jama.294.20.2623. Erratum in: JAMA. 2006 May 17;295(19):2250. PMID: 16304077.



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